Uptake and determinants of seasonal influenza vaccination among healthcare workers in Kirkuk, Iraq: a cross-sectional study

Seasonal influenza represents a significant global health threat, with healthcare workers (HCWs) facing increased risk due to occupational exposure. Despite World Health Organization (WHO) and Centers for Disease Control and Prevention (CDC) recommendations, vaccination coverage among HCWs in many low- and middle-income countries remains inadequate. This study aimed to assess influenza vaccine uptake and its determinants among HCWs in Kirkuk, Iraq. A descriptive cross-sectional study was conducted between November 2024 and July 2025 across 11 public healthcare facilities. A total of 1,379 HCWs completed a validated self-administered questionnaire. Descriptive statistics summarized participant characteristics. Bivariate associations were examined using Chi-square tests, and variables with p < 0.05 were included in a forward stepwise logistic regression model. Odds ratios (ORs) and adjusted odds ratios (AORs) with 95% confidence intervals (CIs) were reported. Overall, 52.4% of HCWs reported receiving the influenza vaccine in the last season. Vaccination uptake was significantly higher among younger HCWs (64.0% in the 20–30 year age group vs. 27.6% in those ≥ 50 years; p < 0.001) and physicians (63.7%) compared to nurses (45.1%). In the adjusted analysis, HCWs aged 31–40 years (AOR = 0.62, 95% CI: 0.45–0.84), 41–50 years (AOR = 0.26, 95% CI: 0.17–0.40), and ≥ 50 years (AOR = 0.24, 95% CI: 0.15–0.39) were significantly less likely to be vaccinated than those aged 20–30 years. Nursing staff also had significantly lower uptake (AOR = 0.49, 95% CI: 0.33–0.72). Positive perceptions of vaccination predicted higher uptake, including considering the vaccine very important (AOR = 0.58, 95% CI: 0.37–0.93) and believing it reduces hospitalizations (AOR = 0.70, 95% CI: 0.50–0.97). The most frequently reported reasons for non-vaccination were concerns about side effects (17.8%), doubts about efficacy (15.8%), and lack of time (14.6%). Access to workshops and supportive institutional strategies were also associated with higher coverage. Influenza vaccination coverage among healthcare workers (HCWs) in Kirkuk is below international targets. To improve uptake, it is essential to address misconceptions, enhance structured educational interventions, and strengthen institutional support. Targeted educational campaigns, peer advocacy, and institutional measures—such as on-site vaccination and supportive workplace policies—are needed to overcome barriers and align HCWs' positive attitudes with consistent vaccination behavior.